Functional fitness benchmark values for older adults: a systematic review.

Introduction: The use of normative values and/or standards of functional fitness in adults is relevant to overall health and well-being. The objectives of the study were: to identify the physical tests of the senior fitness test (SFT) that have been applied since its proposal and to describe the proposed percentiles according to age, sex and country. Methods: A systematic review study was conducted in the Pubmed and Scopus databases. As eligibility criteria, we considered the period from 1999 to 2022 that presented data on SFT test used in the population over 60 years of age and that described normative values through percentiles. MeSH were used as: (1) Physical fitness, Exercise test, Senior Fitness Test, Functional fitness, Cardiorespiratory fitness, (2) older adult, aged, (3) Reference standards, standards, standards of care. Boolean operators "AND" and "OR" were included. Data extracted from the selected studies included: year of publication, country, sample age, sample size, sample sex, fitness component. Results and discussion: Seven studies were identified in five countries (03 in China, 01 in Poland, 01 in Portugal, 01 in Spain and 01 in United States). The age range ranged from 60 to 103 years. The studies were conducted in both sexes. The study with the smallest sample size was by Chung et al. (China) with 944 participants and the largest number of participants was the study by Rikli and Jones in the United States with 7,183 participants. In general, no study was able to complete 100% (8 components) of the tests proposed in the SFT. Normative values were presented through percentile distribution (p10, p50 and p90) organized by age ranges. Males presented better performance in FPF tests than females in all tests. Since the first publication of the SFT until 2022, seven articles have been published in countries such as United States, China (three regional studies), Poland, Portugal and Spain. No study has published the complete battery with its eight components. The percentiles of functional fitness reflect decline with advancing age. Systematic review registration: PROSPERO (CRD42023441294: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023441294).

International microsurgery simulation society (IMSS) consensus statement on the minimum standards for a basic microsurgery course, requirements for a microsurgical anastomosis global rating scale and minimum thresholds for training.

INTRODUCTION: Microsurgery is a surgical technique that uses optical magnification as well as specific instruments to address necessary reconstructive procedures in different medical specialties. The apprenticeship of this technique requires overcoming a steep learning curve. There is a need for standardization of the training criteria in microsurgery. The International Microsurgery Simulation Society (IMSS) was born in 2011, since then its main objective has been to connect the main international specialists and educators of this sub-specialty to share and discuss the ethical and scientific basis of preclinical microsurgery teaching. METHODS: In order to achieve a consensus on the minimum standards for the organization of basic microsurgery training courses, the requirements for a microsurgical anastomosis global rating scale and minimum thresholds for training, a total of nineteen independent global experts participated in a formal consultative consensus development program. The agreement criteria for each statement was established when consensus of 65-100% was reached. RESULTS: There have been established six recommendations concerning minimum standards for a basic microsurgery course, one recommendation in relation to minimum thresholds for training and four recommendations regarding the global rating scale as gold standard for a microsurgical anastomosis assessment. The eleven defined recommendations reached the agreement threshold of 65-100%. CONCLUSIONS: The development of this consensus sets the minimum recommended requirements for conducting basic microsurgery training courses, as well as suggestions for objective assessment of the learning curve and skills of trainees.

Entrenamiento microquirúrgico a distancia / e-Learning microsurgical training

Introducción y Objetivo: Tradicionalmente el entrenamiento microquirúrgico se basa en la tutela presencial de un instructor. Esto presenta ciertas limitantes como la escasez de instructores y el número limitado de alumnos por instructor. El objetivo del presente trabajo es describir un método de entrenamiento y adquisición de destrezas microquirúrgicas basado en un currículum en línea y evaluación dirigida por un instructor a distancia. Material y método: Se entrenaron 6 alumnos de Medicina mediante un curso de dificultad progresiva basado en modelos inanimados y anastomosis arterial término-terminal en muslo y ala de pollo ex vivo. Los alumnos, mediante una plataforma en línea, recibieron vídeos instructivos antes de cada sesión, registraron su actividad y enviaron un vídeo de su entrenamiento al instructor. Las correcciones fueron entregadas a los alumnos por parte del instructor mediante la misma plataforma en línea. Comparamos la sesión inicial y final utilizando escalas de evaluación objetivas para investigar la adquisición de destrezas microquirúrgicas. Resultados: Fue factible implementar un sistema de evaluación a distancia. Todos los alumnos incrementaron sus puntajes al final del entrenamiento. Conclusiones: Mediante el uso de plataformas de formación en línea, es posible incrementar la destreza microquirúrgica sin la presencia física de un instructor, sobrellevando las limitaciones del modelo tradicional

Background and Objective: Traditionally, microsurgical training has been based on a face-to-face tuition. This presents certain limitations such as the shortage of instructors and the limited number of students per instructor. The aim of this study is to describe a method of training and acquisition of microsurgical skills based on an online curriculum and distance based evaluation. Methods: Six medical students were trained through a progressive difficulty program based on non biological models and artery to artery anastomosis using a non living chicken thigh and wing. Using an online platform, the students reviewed the instructional videos for each training lesson, registered their progress and sent a video to the instructor for assessment. Corrections were delivered through the same platform. The initial and final sessions were compared using objective evaluation scales in order to assess the microsurgical skill acquisition. Results: It is feasible to implement a remote evaluation system. All students increased their scores at the end of training. Conclusions: Using instructional on line platforms, it's possible to increase the microsurgical skill without the physical presence of an instructor, overcoming the limitations of the traditional model

Augmented reality and dynamic infrared thermography for perforator mapping in the anterolateral thigh.

Dynamic infrared thermography (DIRT) has been used for the preoperative mapping of cutaneous perforators. This technique has shown a positive correlation with intraoperative findings. Our aim was to evaluate the accuracy of perforator mapping with DIRT and augmented reality using a portable projector. For this purpose, three volunteers had both of their anterolateral thighs assessed for the presence and location of cutaneous perforators using DIRT. The obtained image of these "hotspots" was projected back onto the thigh and the presence of Doppler signals within a 10-cm diameter from the midpoint between the lateral patella and the anterior superior iliac spine was assessed using a handheld Doppler device. Hotspots were identified in all six anterolateral thighs and were successfully projected onto the skin. The median number of perforators identified within the area of interest was 5 (range, 3-8) and the median time needed to identify them was 3.5 minutes (range, 3.3-4.0 minutes). Every hotspot was correlated to a Doppler sound signal. In conclusion, augmented reality can be a reliable method for transferring the location of perforators identified by DIRT onto the thigh, facilitating its assessment and yielding a reliable map of potential perforators for flap raising.

Uso de colgajos perforantes para el tratamiento de hidradenitis supurativa axilar y esternal graves / Use of perforator flaps for treatment of severe axillary and sternal hidradenitis suppurativa

Resumen Objetivo: Presentar una serie de reconstrucciones con colgajos perforantes en pacientes con casos severos de hidradenitis supurativa y sus resultados. Pacientes y métodos: Se realizaron 7 reconstrucciones axilares y un caso de reconstrucción esternal en 5 pacientes. Todos los pacientes correspondieron a la clasificación II o III de Hurley, y fueron derivados a nuestro servicio después de por lo menos un año de tratamiento médico sin obtener resultados. El equipo de cirugía plástica realizó tanto la resección como la reconstrucción en todos los casos. Los vasos perforantes fueron marcados con un dispositivo Doppler sonido. Resultados: Se obtuvo cobertura en todos los casos, con solo una pérdida parcial de colgajo que fue resuelta con curaciones. Tras un seguimiento de 26 meses, no hubo recidiva de hidradenitis supurativa. Todas las reconstrucciones evolucionaron con resultados funcionales óptimos. Conclusión: Los colgajos perforantes son una buena alternativa para el tratamiento de casos severos de hidradenitis supurativa, tanto esternal como axilar. Por esta razón, debe ser considerado en el armamento de cirujanos plásticos que traten esta enfermedad, una vez que el tratamiento médico haya fallado.

Abstract Aim: To present a brief series of reconstructions with perforator flaps in severe cases of hidradenitis suppurativa patients and results. Patients and methods: Seven axillary and one sternal case in five patients were operated on. All patients were in stage II or III according to Hurley classification, and were referred after at least one year of medical treatment with no satisfactory result. The plastic surgery team performed both, resection and reconstruction in all cases. Perforator vessels were marked using a handheld Doppler device. Results: One partial flap failure occurred, which healed with standard wound care. After a median follow up of 26 months, no relapse of hidradenitis suppurativa occurred. All reconstructions evolved with full functional results. Conclusion: Perforator flaps are a good choice in the treatment of severe cases of hidradenitis suppurativa, both sternal and axillary. It should be considered in the armamentarium of any plastic surgeon treating patients with this condition, once the medical treatment has failed.

Do textured breast implants decrease the rate of capsular contracture compared to smooth implants? / ¿Implantes mamarios texturizados o lisos para disminuir la tasa de contractura capsular?

The use of breast implants for aesthetic and reconstructive purposes has become one of the most common procedures performed by plastic surgeons. Several breast implants models exist. They differ in their size, filling, shape and characteristic of the shell, which can be smooth or textured. Capsular contracture is one of the main complications of breast implants. It has been suggested that the use of textured implants could reduce the incidence of capsular contracture. To answer this question, we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We identified 15 studies overall, of which 13 were randomized trials relevant for the question of interest. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. We concluded the use of textured breast implants probably decreases the risk of capsular contracture, however, they might be associated to an increased risk of anaplastic large cell lymphoma.

El uso de implantes mamarios con propósitos estéticos y reconstructivos se ha convertido en uno de los procedimientos más comunes realizados por los cirujanos plásticos. Existen diversos modelos de implantes mamarios, los cuales difieren en su tamaño, relleno, forma y característica de la envoltura, pudiendo ser lisa o texturizada. La contractura capsular es una de las principales complicaciones del uso de implantes mamarios y se ha planteado que las prótesis texturizadas podrían disminuir la incidencia de contractura capsular. Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud a nivel mundial, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Identificamos cinco revisiones sistemáticas que en conjunto incluyen 15 estudios primarios, 13 de ellos correspondientes a ensayos aleatorizados pertinentes a la pregunta de interés. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el uso de prótesis mamaria texturizada probablemente disminuye el riesgo de contractura capsular, sin embargo, podría asociarse a un aumento en el riesgo de linfoma anaplásico de células grandes.

CLOVES Syndrome: Severe Neonatal Presentation.

Congenital Lipomatous Overgrowth, Vascular Malformations, Epidermal Nevi and Spinal Abnormalities (CLOVES syndrome) is a newly described and rare overgrowth disorder with serious morbidity. The course of this disease is not well understood and few cases have been reported among neonates. Moreover, not all of the signs of this syndrome are present at birth, making a high index of suspicion necessary. We present a cohort of three newborns with CLOVES syndrome who died due to septic and hemodynamic complications directly related to extensive vascular malformations. We discuss the clinical presentation in the neonatal period and propose a clinical classification.

Evaluación de la microcirculación con sidestream dark field (SDF) Microscan® como método de monitorización en microcirugía en modelo porcino / Microcirculation assessment with sidestream dark field (SDF) Microscan® as flap monitoring method in microsurgery in a porcine model

Objetivo: Determinar la factibilidad de la monitorización en microcirugía por medio de la evaluación no invasiva de la microcirculación con sidestream dark field (SDF) y compararla con otros métodos. Materiales y métodos: Estudio experimental. En 8 cerdos se elevó colgajo pectoral y se disecó pedículo. Se llevó a cabo una instalación sucesiva de dispositivos cutáneos para la evaluación de la microcirculación: SDF para evaluar flujo, y near infrared spectroscopy (NIRS) para evaluar saturación de O2 (SatO2). Posteriormente se evaluó la oclusión venosa, arterial y total con pinzamiento durante 180 s. Resultados: SDF en oclusión venosa: disminución del flujo: 51 s (59-62); SDF en oclusión arterial: disminución del flujo: 3 s (1-5); SDF en oclusión vascular total: disminución del flujo: 3,5 s (2-5). NIRS en oclusión venosa: disminución de la SatO2:15,2 ± 5,3%; NIRS en oclusión arterial: disminución de la SatO2 23,9 ± 13,8%; NIRS en oclusión vascular total: disminución de la SatO2 23,85 ± 13,9%. Doppler en oclusión venosa: no desapareció; Doppler en oclusión arterial y oclusión vascular total: desapareció a los 2 s. En cada una de las mediciones, los cambios clínicos fueron más tardíos que los observados con SDF. Conclusión: Es factible la monitorización en microcirugía por medio de la evaluación de la microcirculación con Microscan®. Este método permite realizar el diagnóstico de oclusión vascular más tempranamente que con NIRS y evaluación clínica.

Aim: Determine the feasibility of using SDF Microscan® as a non-invasive method for monitoring free flap microcirculation, and compare it to other methods. Materials and methods: Experimental study. In 8 pigs a pectoral myocutaneous flap was raised. Microcirculation was evaluated using: SDF Microscan®, near infrared spectroscopy (NIRS), clinical examination and Doppler. Venous, arterial and total occlusion was performed by clamping the vascular pedicle. Mean time to blood flow impairment diagnosis was measured. Results: SDF in venous occlusion: reduced microcirculatory flow index at: 51 s (59-62). SDF in arterial occlusion: reduced microcirculatory flow index at: 3 s (1-5). SDF in total vascular occlusion: reduced microcirculatory flow index at: 3.5 s (2-5). NIRS in venous occlusion: SatO2 decrease was 15.2 ± 5.3%. NIRS in arterial occlusion: SatO2 decrease was 23.9 ± 13.8%. NIRS in total vascular occlusion: SatO2 decrease was 23.85 ± 13.9%. Doppler in venous occlusion: The signal did not disappear. Doppler arterial and total vascular occlusion disappears at 2 s. The clinical changes were later than SDF. Conclusion: Microcirculation monitoring is feasible using SDF Microscan® in a pig model. This method allows to detect blood flow disruption earlier than NIRS and clinical evaluation.

A Novel Perforator Flap Training Model Using a Chicken Leg.

INTRODUCTION: Living animal models are frequently used for perforator flap dissection training, but no ex vivo models have been described. The aim of this study is to present a novel nonliving model for perforator flap training based on a constant perforator in the chicken leg. METHODS: A total of 15 chicken legs were used in this study. Anatomical dissection of the perforator was performed after its identification using ink injection, and in four of these specimens a perforator-based flap was raised. RESULTS: The anatomical dissection revealed a constant intramuscular perforator with a median length of 5.7 cm. Median proximal and distal vessel diameters were 0.93 and 0.4 mm, respectively. The median dissection time was 77.5 minutes. CONCLUSION: This study introduces a novel, affordable, and reproducible model for the intramuscular dissection of a perforator-based flap using an ex vivo animal model. Its consistent perforator and appropriate-sized vessels make it useful for training.

Microsurgery Workout: A Novel Simulation Training Curriculum Based on Nonliving Models.

BACKGROUND: Currently, there are no valid training programs based solely on nonliving models. The authors aimed to develop and validate a microsurgery training program based on nonliving models and assess the transfer of skills to a live rat model. METHODS: Postgraduate year-3 general surgery residents were assessed in a 17-session program, performing arterial and venous end-to-end anastomosis on ex vivo chicken models. Procedures were recorded and rated by two blinded experts using validated global and specific scales (objective structured assessment of technical skills) and a validated checklist. Operating times and patency rates were assessed. Hand-motion analysis was used to measure economy of movements. After training, residents performed an arterial and venous end-to-end anastomosis on live rats. Results were compared to six experienced surgeons in the same models. Values of p < 0.05 were considered statistically significant. RESULTS: Learning curves were achieved. Ten residents improved their median global and specific objective structured assessment of technical skills scores for artery [10 (range, 8 to 10) versus 28 (range, 27 to 29), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 28), p < 0.05] and vein [8 (range, 8 to 11) versus 28 (range, 27 to 28), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 29), p < 0.05]. Checklist scores also improved for both procedures (p < 0.05). Trainees were slower and less efficient than experienced surgeons (p < 0.05). In the living rat, patency rates at 30 minutes were 100 percent and 50 percent for artery and vein, respectively. CONCLUSIONS: Significant acquisition of microsurgical skills was achieved by trainees to a level similar to that of experienced surgeons. Acquired skills were transferred to a more complex live model.

A Novel Ex Vivo Training Model for Acquiring Supermicrosurgical Skills Using a Chicken Leg.

Background Supermicrosurgery is a technique used for dissection and anastomosis of submillimeter diameter vessels. This technique requires precise hand movements and superb eye-hand coordination, making continuous training necessary. Biological in vivo and ex vivo models have been described for this purpose, the latter being more accessible and cost-effective. The aim of this study is to present a new ex vivo training model using a chicken leg. Methods In 28 chicken legs, an anatomical study was performed. An intramuscular perforator vessel was identified and dissected. Arterial diameters of 0.7, 0.5, and 0.3 mm were identified and consistency of the perforator was assessed. In additional 10 chicken legs, 25 submillimeter arteries were anastomosed using this perforator vessel. Five arteries of 0.3 and 10 of 0.5 mm were anastomosed with nylon 11-0 and 12-0 sutures. Intravascular stent (IVaS) technique and open guide (OG) technique were used in 0.5-mm arteries. A total of 10 arteries of 0.7 mm were anastomosed using 10-0 sutures in a conventional fashion. Dissection and anastomosis time were recorded and patency was tested. Results We were able to identify 0.7 to 0.3 mm diameter arteries in all the specimens and confirm the consistency of the perforator. The median time for dissection was 13.4 minutes. The median time for anastomosis was 32.3 minutes for 0.3-mm arteries, 24.3 minutes for 0.5-mm arteries using IVaS, 29.5 minutes for the OG technique, and 20.9 minutes for the 0.7 mm diameter arteries. All the anastomoses were permeable. Conclusion Due to its consistent and adequate diameter vessels, this model is adequate for training supermicrosurgical skills.

[Early and late morbidity and mortality of aortic valve replacement with mechanical or biological prostheses during the last decade: the gold standard]. / Morbimortalidad precoz y alejada del reemplazo valvular aórtico con prótesis mecánica y biológica durante la última década: El estándar de oro.

BACKGROUND: There is a growing interest in alternative techniques for aortic valve replacement (AVR). Therefore it is important to have updated results of conventional AYR as a valid comparative standard. AIM: To evaluate both perioperative and late morbidity and mortality in patients undergoing conventional AVR, with either mechanical (RVAm) or biological (RVAb) prostheses. PATIENTS AND METHODS: Retrospective review of medical records and operative protocols of patients undergoing AVR between January 1995 and December 2005. Patients with previous cardiac surgery, aortic balloonplasty or simultaneous cardiovascular procedures were excluded. RESULTS: During the study period, 788 patients underwent AVR and 317 met the inclusion criteria. Of the latter, 175 patients aged 13 to 83 years (63% males) were subjected to AVRm and 142 patients aged 49 to 87 years (64% males), were subjected to AVRb. Five (1.6%) patients died during the perioperative period (one AVRm and four AVRb). All were older than 65 years. Perioperative complications were recorded in 29 and 25% of patients in AVRm and AVRb groups, respectively (NS). During a median follow-up of six years, complications were recorded in 12 and 4% of patients in AVRm and AVRb groups, respectively (p <0.05). The actuarial survival for AVRm group at 1, 5 and 10 years, was 96, 92 and 87%, respectively. The figures for AVRb group were 95, 86 and 83%, respectively (NS). The 10 year reintervention free survival was 97% for the AVRm group and 84% for the AVRb (p <0.05). CONCLUSIONS: Perioperative mortality and rates of complications of AVR in this series of patients are low, which compares favorably with other series.

Morbimortalidad precoz y alejada del reemplazo valvular aórtico con prótesis mecánica y biológica durante la última década: El estándar de oro / Early and late morbidity and mortality of aortic valve replacement with mechanical or biological prostheses during the last decade: The gold standard

Background: There is a growing interest in alternative techniques for aortic valve replacement (AVR). Therefore it is important to have updated results of conventional AYR as a valid comparative standard. Aim: To evaluate both perioperative and ¡ate morbidity and mortality in patients undergoing conventional AVR, with either mechanical (RVAm) or biological (RVAb) prostheses. Patients and methods: Retrospective review of medical records and operative protocols of patients undergoing AVR between January 1995 and December 2005. Patients with previous cardiac surgery, aortic balloonplasty or simultaneous cardiovascular procedures were excluded. Results: During the study period, 788 patients underwent AVR and 317 met the inclusion criteria. Of the latter, 175patients aged 13 to 83years (63 percent males) were subjected to AVRm and 142patients aged 49 to 87 years (64 percent males), were subjected to AVRb. Five (1.6 percent) patients died during the perioperative period (one AVRm and four AVRb). All were older than 65years. Perioperative complications were recorded in 29 and 25 percent of patients in AVRm and AVRb groups, respectively (NS). During a median follow-up of six years, complications were recorded in 12 and 4 percent of patients in AVRm and AVRb groups, respectively (p <0.05). The actuarial survival for AVRm group at 1, 5 and 10years, was 96, 92 and 87 percent, respectively. The figures for AVRb group were 95, 86 and 83 percent, respectively (NS). The 10 year reintervention free survival was 97 percent for the AVRm group and 84 percent for the AVRb (p <0.05). Conclusions: Perioperative mortality and rates of complications of AVR in this series of patients are low, which compares favorably with other series (Rev Méd Chile 2009; 137:1153-62).